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❑ Keller Canyon ❑ Ox Mountain ❑ Newby Island90 <br /> Forward <br /> Sanitary'tandfill. Sanitary Landfill Sanitary Landfill Landfill <br /> 9Q1 Bailey Road ` 12310 San Mateo Road 1601 Dixon Landing Road 9999 S.Austin Road <br /> A tsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone(925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Phone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR WASTE ACCEPTANCE NO. <br /> pacific r_..., o. Ic1... ;i0 <br /> MAILING ADDRESS <br /> A(100— <br /> Code B24 AY 7117 <br /> CITY TATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> PHONESan EranriwA)' CA 94120 U GLOVES O GOGGLES U RESPIRATOR U HARD HAT <br /> ❑TY VEK U OTHER <br /> CON <br /> SPECIAL HANDLING PROCEDURES: <br /> SIGN HORI ED AGENT/TITLE DATE <br /> zot111,geat€or <br /> (( 1 Q C3 S& actric � f y <br /> GENERATOR'S CERTIFICATION:I hereby !! lone <br /> certify that the above named material is not a hazardous <br /> waste as defined by 40 CFR Part 261 or title 22 of the California code of regulations,has been properly <br /> described,classified and packaged,and is in proper condition for transportation axording to applicable <br /> regulations;AND,it the weals Is a treatment residue of a previously restricted hazardous waste <br /> subject to the Land Disposal Restrictions,I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 40 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261. <br /> WASTE TYPE: <br /> ISPOSAL O SLUDGE <br /> O CONSTRUCTION O WOOD <br /> U DEBRIS O OTHER <br /> O SPECIAL WASTE <br /> GENERATING FACILITY <br /> Thurnion Dch drator Thornton <br /> TRANSPORTER NOTES: VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> — . este.1._ nation -- , <br /> ADDRESS (r� <br /> R7.D T)enRmte C1 <br /> CITY,STATE,ZIP - _ 13 <br /> PHON END DUMP BOTTOM DUMP TRANSFER <br /> ❑ ❑ <br /> SIGN A RIZE AGENT OR DRIVER DATE ROLL-OFF(S) FLAT-BED VAN RUMS <br /> -/,/ f I /// ❑ ❑ ❑ ❑ <br /> CUBIC YARDS <br /> 1 hereby certify that the above named material has been <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD: (TO BE COMPLETED BY LANDFILL) <br /> is true and accurate. <br /> DISPOSE OTHER <br /> REMARKS o SOIL <br /> O CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> ASBESTOS <br /> SIGNATURE OF AUTHORIZED AGENT DATE <br /> U WOOD <br /> U ASH <br /> U SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL-ANY UNSCHEDULED LOADS ARE SUBJECT <br /> `TO REFUSAL.UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST# 1 4 7 n n 7 <br />